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    This document discusses bowel obstruction, including its causes, symptoms, diagnosis, and management. Bowel obstruction occurs when the bowel lumen is blocked, preventing the passage of materials and can be caused by factors intrinsic or extrinsic to the bowel. Common causes include adhesions, hernias, tumors, and gallstones. Symptoms include abdominal pain, distension, vomiting, and inability to pass gas or stool. Diagnosis involves clinical examination and radiological imaging like abdominal x-rays or CT scans. Treatment depends on the severity and cause but may involve conservative management with NG tubes and IV fluids or surgery to remove obstructions or resect diseased bowel segments. Bowel obstruction represents a significant healthcare burden with over 300

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    This document discusses bowel obstruction, including its causes, symptoms, diagnosis, and management. Bowel obstruction occurs when the bowel lumen is blocked, preventing the passage of materials and can be caused by factors intrinsic or extrinsic to the bowel. Common causes include adhesions, hernias, tumors, and gallstones. Symptoms include abdominal pain, distension, vomiting, and inability to pass gas or stool. Diagnosis involves clinical examination and radiological imaging like abdominal x-rays or CT scans. Treatment depends on the severity and cause but may involve conservative management with NG tubes and IV fluids or surgery to remove obstructions or resect diseased bowel segments. Bowel obstruction represents a significant healthcare burden with over 300

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    © All Rights Reserved
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    10 views25 pages

    Bowel Obstruction1

    Uploaded by

    Pradipta Shiva
    This document discusses bowel obstruction, including its causes, symptoms, diagnosis, and management. Bowel obstruction occurs when the bowel lumen is blocked, preventing the passage of materials and can be caused by factors intrinsic or extrinsic to the bowel. Common causes include adhesions, hernias, tumors, and gallstones. Symptoms include abdominal pain, distension, vomiting, and inability to pass gas or stool. Diagnosis involves clinical examination and radiological imaging like abdominal x-rays or CT scans. Treatment depends on the severity and cause but may involve conservative management with NG tubes and IV fluids or surgery to remove obstructions or resect diseased bowel segments. Bowel obstruction represents a significant healthcare burden with over 300

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
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    of 25

    James Zeng

    Bowel Obstruction
     A blockage of bowel lumen prohibiting the
    passage of materials[1]

     8% of abdo pain in ED (3rd leading cause)[2]


     24% require surgery[3]
     300,000 admissions, 800,000 in-pt days,
    $1.3bil[4]
    Causes
     Extrinsic (extraluminal)
     Intrinsic (luminal)
     Intraluminal
    Extrinsic Causes
     Adhesions
     Hernias
     Volvulus
    Intrinsic
     Neoplastic
     Inflammatory
     Congenital
    Intraluminal
     Faeces
     Gallstones
     Intussception
     Bezoar
    Bowel Obstruction
     Small v. Large
     Acute v. subacute
    Differential
     Paralytic -ileus
     Pseudo-obstruction
     Constipation
    Diagnosis
     Clinical
     Radiological
    Symptoms
     Pain
     Distension
     Obstructive symptoms
     Vomiting
     Inability to pass motions/slowing
     Inability to pass flatus
    Past history
     Past abdominal surgery
     Past obstructions
     Hernias
     Crohn’s
     Malignancy
    Signs
     Volume status
     Scars, volume
     Guarding, peritonitis
     “Tinkling” bowel sounds, no BS
     Hernias
     PR
    Investigations
     Abdo pain bloods
     Lactate
    Radiology (AxR)
    Radiology (AxR)
     Large bowel obs
    Radiology (AxR)
     Size
     Walls
     Distal collapse
     Empty rectum
    Radiology (AxR)
    Small Large
    Central Peripheral
    Smaller calibre Larger calibre
    Valvulae coniventes Haustra
    More loops 1-2 loops
    Long fluid levels Short fluid levels
    Radiology (CT)
     Inconclusive XR
     Systemically unwell, local peritonitis
     Helps to determine cause
     >2.5cm with distal collapse
     High accuracy
    Conservative Management
     Fluids
     NBM
     Analgesia
     NG tube
    Complications
     Electrolytes
    Specific Management
     Adhesions - conservative ± gastrograffin
     Perforation, hernia – urgent theatre
     Strictures, colitis – surgical resection
     Sigmoid volvulus – rectal tube

     Beware of ischaemia – test intraoperatively


    Obstruction in Cancer Patients
     Various opinions
     Depends on when last operation was
     Trial of conservative treatment
     Gastrograffin/CT
     Consider early resection, stent+resection

     Non-operative candidates
    References
    1. www.medical-dictionary.com
    2. Lewis LM et al. Etiology and clinical course of abdominal
    pain in senior patients: a prospective, multicenter study.
    Gerontol A Biol Sci Med Sci. 2005. 60:8 (1071-6).
    3. Foster NM; McGory ML; Zingmond DS; Ko CY. Small
    bowel obstruction: a population-based appraisal. J Am
    Coll Surg. 2006. 203:2 (170-6).
    4. Ray NF; Denton WG; Thamer M; Henderson SC; Perry S.
    Abdominal adhesiolysis: inpatient care and expenditures
    in the United States in 1994. J Am Coll Surg. 1998. 186:1 (1-
    9).

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